Death Notification

Table of Contents

About the Author
Introduction
Part One: The Notification Process
  1. Initiating the Notification Process
    Within a Hospital
    *Notification by a Physician...Notification by a Nurse...Notification by a Psychotraumatologist...Notification Complexity...Case Vignette 1.1
    In the Field
    *Field Notifier Selection Guidelines...Law Enforcement Officers...Emergency Medical/Fire Department Staff...Coroners Staff...Military Personnel
    Legal Issues in Notification
    Contraindicators for Designers

  2. Information Gathering
    Identification of the Deceased
    *Accident Co-victims...Ambulance/Transport Staff...Law Enforcement Staff...Contents of the Deceased's Pockets...Miscellaneous Papers and Cards...Other Belongings...Telephone Directory Assistance...Vehicle Registrations...Physical Description...Fingerprints/Missing Persons Reports...Cautionary Notes
    Family Contact
    *Timely Notice...Family Confirmation of Identity
    Death Debriefing
    *Military Issues
    Information and Crisis Management
    *Drug Abuse Deaths...Homicide...Complicating Information
    Conclusions

  3. Notification Staging and Delivery
    Initial Family Contacts
    *Timing the Notification...Telephone Contacts...Telephone Notification "On Demand"
    Selection of Physical Surroundings
    Notification Technique
    *Sequential Notification...Accidental Death...Natural Death...Resuscitation in Progress...Emotional Support
    Screening the Information Released
    Extrapolation of Techniques

  4. Special Issues in Notification
    Long-Distance Notification
    *Travel Time...Telephone Contacts...Case Vignette 4.1...Case Vignette 4.2
    Anticipatory Notifications
    *Case Vignette 4.3
    Telling Children
    *Case Vignette 4.4
    On-Scene Notifications
    *Assessment of Bereft...Surroundings Selection...Notification Delivery...Viewing a Body On-scene...Support and Follow-up
    Notification Contraindicators
    *Accident Co-victims...Surgery or Sedation...Traumatic Brain Injuries...Survivors on Respiratory Support...Alcohol and Drugs
    Homicide

  5. Notification Follow-up
    Debriefing
    *Loss Context...Religious Support Contact...Additional Family Contacts...Helpful Family and Friends
    Viewing the Body
    *You're First...Family Reluctance...Viewing and Denial...Death Phobias...Preparation of the Body...Positioning of the Body...Escorting Family to the Viewing...Viewing Children/Infants...Photographs
    Consent for Autopsy
    Funeral Arrangements
    *Funeral Expenses...Therapeutic Involvement...Vignette 5.1
    Assessment and Referral
    *Bereavement Literature...Counseling and Support Group Referrals...Follow-up Letters
    Public Information Release

  6. Organ and Tissue Donation
    The Need and the Benefits
    Family Preparation (with suggested dialogue)
    Religious Perspectives on Donation
    Cautionary Notes
    *Case Vignette 6.1

Part Two: Grief Management
  1. Grief Reaction Theories and Typical Notification Responses
    Making Room for Grief
    *Case Vignette 7.1...Case Vignette 7.2
    Understanding Grief
    *The Physiology of Grief...The Behaviors of Grief...Theories of Grief Resolution Patterns
    Identifying Coping Patterns
    Typical Notification Responses
    *Holistic Grief...Action-Oriented Grief...Inordinately Calm Responses...Emotional Withdrawal...Extreme Guilt...Situational Blaming...Grief and Anger
    Demonstrative Notification Responses
    *Highly Vocalized Grieving...Striking Out Reactions...Self-Striking Reactions...Emotive Chanting
    Management Strategies
    *Family Crises...Case Vignette 7.3
    Physiological Responses

  2. Pathological Grief
    Family Disfunction
    *Case Vignette 8.1
    Suicidal Ideation
    *Case Vignette 8.2
    Violent Behavior
    Homicidal Ideation
    *Tarasoff Regulations
    Grief Influenced by Drugs and Alcohol
    Extreme Denial
    *Case Vignette 8.3
    Signs of Pathological Grief

  3. Bereavement Perspectives
    Bereavement Relationships
    *Death of a Spouse/Significant Other...Death of a Child...Case Vignette 9.1...Death of a Parent...Death of a Friend
    Children's Perspectives of Death
    *Special Concerns
    Cultural Issues
    *Case Vignette 9.2
    Mode of Death
    *Stillborn...Case Vignette 9.3...Sudden Infant Death Syndrome...Abortion...Suicide...Substance Abuse...Murder...Drunken Driving
    Conclusion

  4. Family Assessment and Crisis Intervention
    Physical Assessment
    Emotional Assessment
    Support Systems Assessment
    Mental Status Examinations
    Counseling Techniques for Crisis Intervention
    *The Crisis Intervention Model...Case Vignette 10.1
    Follow-up Needs Assessment
    *Eustress vs. Distress...Preventive Intervention...High-Risk Bereavement Follow-up Check List

  5. Grief Management Strategies
    Primary Goals
    Actualizing Support for the Bereaved
    *Allow Natural Expression...Viewing the Body (Therapeutic)
    Verbal Support for the Bereaved
    *What Not to Say...Potential Dialogue Topics...Life Telling...Fairness...Owning the Pain...The Learning Experience...The Gifts of Love...The Broken Leaf...Life's Pictures...The "Magic Wand"...Reasoning...Religious Views
    Guidelines for Friends of the Bereaved
    Professional Preparation
    *Case Vignette 11.1
    Recognizing Your Limits
    Staff Grief and Stress Management
    *Case Vignette 11.2

  6. Delivering a Terminal Diagnosis
    The Physician's Unavoidable Responsibility
    The Importance of the Task
    *Case Vignette 12.1
    Preliminary Steps
    *Staging the Delivery of the News...The Potential for Emotional Reactions, Including Yours
    The Language of Disclosure
    *Timing Delivery of the News...Exploration of What is Already Known...Assessment of the Wish to Be Informed..."Offering" Truth...Case Vignette 12.2...Informed Consent
    Delivery of the News
    *Key Concepts...Practical Application...Let There Be Hope...Use of Humor in Notification
    Responses and Family Perspectives
    *"So, Doctor, how much time do I have?"...Comments on Denial...Cultural Issues...Therapeutic Privilege...Suicide Management
    Necessary Follow-up
    *The Treatment Plan...Case Vignette 12.3...Treatment Plan "Evolution"...Case Vignette 12.4
    Accepting the Patient's Choices
    *Advance Directives...Do Not Resuscitate Orders...Case Vignette 12.5...Hospice
    Extrapolation of Techniques
    Medical Training
    *Case Vignette 12.6

Part Three: Research Presentation
  1. Formal Research Examined
    Introduction...Assumptions...Research Format...Design...Content...Subjects...Weaknesses...Analysis of the Data...Demographic Commentary...Survey Opinions...Research Summary...Conclusion

Appendices
  1. Telephone Contact Checklist
  2. Tissue Donation Protocol
  3. Organ Donation Protocol
  4. Legal Next-of-Kin Determination
  5. Organ/Tissue Donor Designation in the Absence of Legal Next-of Kin
  6. Religious Views on Organ/Tissue Donation
  7. Media/Information Release Protocol
  8. Acute Symptoms of Grief
  9. Normal Grief Symptoms and How to Cope With Them
  10. Resources for Bereavement
  11. Family Funeral Checklist
Bibliography
Index

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